Provider Demographics
NPI:1629136882
Name:LINBOOM, CHRISTINA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:L
Last Name:LINBOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 S PROMONTORY DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1002
Mailing Address - Country:US
Mailing Address - Phone:773-753-8642
Mailing Address - Fax:773-247-2188
Practice Address - Street 1:6501 S PROMONTORY DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1002
Practice Address - Country:US
Practice Address - Phone:773-753-8642
Practice Address - Fax:773-247-2188
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149.0133281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.013328OtherIL DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION- SOCIAL WORK BOARD